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What is PMDD? (Premenstrual Dysphoric Disorder)

Premenstrual dysphoric disorder (PMDD) is a major depressive disorder and is defined in the latest version of the Diagnostic and Statistic Manual of Mental Disorders (DSM-IV-TR). Premenstrual dysphoric disorder is a mental illness that describes mood changes occurring exclusively during the two weeks before menses. While 80% of women experience some physical and emotional problems during this time, only 3% - 8% meet the definition of PMDD. Premenstrual dysphoric syndrome is most commonly found in women in their late-30s to mid-40s.1

Premenstrual Dysphoric Disorder (PMDD) Symptoms

Premenstrual dysphoric disorder symptoms are similar to those in major depression with the most common symptom being irritability. Physical PMDD symptoms of breast pain and bloating, as well as its timing, differentiate PMDD from standard major depression. PMDD is associated with an increased risk of suicide when the patient is symptomatic.

Other physical symptoms, such as headaches, joint or muscle pain or weight gain

In addition to the above PMDD symptoms, to be diagnosed with PMDD these symptoms must occur only during the two weeks before menses for at least two consecutive cycles. Other diagnostic criteria for PMDD include:

The symptoms of PMDD must be severe enough as to interfere with day-to-day functioning (for example, avoiding friends or decreased productivity at work).

The symptoms must not be an exacerbation of another illness.

Premenstrual Dysphoric Disorder (PMDD) Treatment

There are several treatments available for premenstrual dysphoric disorder. Both pharmacological and lifestyle changes are options for PMDD treatment. Dietary changes such as abstaining from caffeine, reducing sodium and avoiding alcohol may be helpful. Exercise is also helpful in treating the symptoms of PMDD.

Other non-pharmacological treatments for PMDD include:

Relaxation therapy – reduces blood pressure, heart rate, rate of breathing and slows brain waves. Therapy may be specific to PMDD or general as in yoga or meditation. Studies show conflicting results on efficacy.

Sleep deprivation – as in major depressive disorder, those with PMDD seem to respond to sleep deprivation treatment. Depressive symptoms of PMDD were reduced after a night of recovery sleep following a night of sleep deprivation.

Cognitive behavioral therapy (CBT) – focuses on anger control as well as emotion and thought restructuring. Although clinical evidence suffers from poor study design, CBT is thought to be effective. (more information on: Therapy for Depression)

Medication treatment is also available for PMDD. Antidepressants, anxiolytics (anti-anxiety) and mood stabilizers are all commonly used. Other pharmacological PMDD treatments with supporting clinical evidence include: